1. Authors: Armando Miciano M.D. 1 Robert Castillo, M.S., B.S. Chad Cross, PhD, Pstat(R) 2 Presenter: Armando Miciano MD 1. Nevada Rehabilitation Institute, Las Vegas NV 2. Crossroads Wellness LLC, Las Vegas NV American Academy of Physical Medicine & Rehabilitation 2014 Annual Assembly, San Diego CA, November 13-16 2014 Research – Pain & Spine Medicine: Scientific Presentation

2.  Inclusion of functional measures into outcome determination of individuals with chronic low back pain (CLBP) using a patient- centered approach may provide the factors most potent for care planning.  A core set of measures should include the following five domains: back specific function, generic health status, pain, work disability, and patient satisfaction. [1] [1] Bombardier C. Spine (Phila Pa 1976). 2000 Dec 15;25(24):3100-3.

3.  Describe a measurement system based on five cardinal constructs of the core set of patient-reported outcome (PRO) measures for CLBP:  1. Symptom quality  2. Pain-related impairment (PRI)  3. Life quality/satisfaction (LQS),  4. Global health status (GHS), and  5. Work disability.

4.  Retrospective study  outpatient PM&R clinic

5.  Individuals with CLBP sub-divided to:  Study group (SG) ◦ n=60 ◦ defined by those with PROMIS-57 Pain Impact (PROMIS-PI) T-scores >/=60  Comparison group ◦ n=11 ◦ defined as those with PROMIS-PI <60.  The International Classification of Functioning (ICF) framework (body functions/structures, activity, participation) was used to classify the PRO used: ◦ Numerical Rating Scale (NRS) to describe symptom quality; ◦ Pain Disability Questionnaire (PDQ), Modified Oswestry Disability Index (MODI), and Roland-Morris Questionnaire (RMQ) for PRI; ◦ PROMIS-57 Satisfaction with Social Role (PROMIS-SSR) for LQS; ◦ PROMIS-57 Physical Function (PROMIS-PF) for GHS; and, ◦ Work Productivity & Activity Impairment for work disability.

6. Body Functions & Structures Numerical Rating Scale (NRS) Activity PDQ MODI RMDQ Participation PROMIS-57 v1.0 WPAI: GH PDQ=Pain Disability Questionnaire; MODI = Modified Oswestry Disability Index; RMDQ = Roland-Morris Disability Questionnaire; WPAI: GH = Work Productivity & Activity Impairment: General Health

7. Symptom quality Pain-related Impairment Life Satisfaction Global Health Status Work Productivity Numerical Rating Scale (NRS) Generic: i.PDQ Disease- specific: i.MODI ii.RMDQ PROMIS-57 - Satisfaction with Social Role PROMIS-57 Physical Function WPAI: GH

8.  Owing to sample size difference, a nonparametric test, Mann-Whitney U-Test, was used to compare scores between groups.  In all cases a statistically significant difference was found between groups: ◦ NRS (U=146;p=.006); ◦ PDQ (U=73;p<.001); ◦ MODI (U=46.5;p<.001); ◦ RMQ (U=73.5;p<.002); ◦ PROMIS-SSR (U=118.5;p<.001); and, ◦ PROMIS-PF (U=72;p<.001).

9.  Significant positive association between: ◦ SG and impairment  Cramer’s V=.357,p =.004 ◦ SG and employment status  Cramer’s V=.283,p =.005  Significantly greater proportion of the SG: ◦ Had severe/extreme PRI  67% vs. 18%;G2=9.220,p=.005 ◦ Was unemployed  68% vs. 30%;G2=5.207,p=.032  as compared to the comparison group.

10.  Individuals with CLBP and a high pain impact reported: ◦ higher pain severity, ◦ more severe/extreme pain-related impairment, ◦ decreased LQS, ◦ lower GHS, ◦ no work productivity.

11.  Study supports the concept of the five cardinal constructs of the PRO core set for CLBP.  Future research should be on whether patient’s satisfaction with quality of care provided is influenced when these constructs are assessed.